P - 80729RE(�UEST FOR ELECTRICAL (NSPECTION �
8 Q�,� ��� � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
. Phone (612) 642-0800
o e Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this reqvest. Enter remarks in lhis space and on the back of the white copy only.
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Calculate inspection Fee - 7his Inspection Request will not be accepted wiihout th cor i fee:
Other Fee # Service Entrance Size Fee # Circuits/feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. /�I�% � `� � D� ��
Alarm/Remote Control
Swimming Pool
I here certi that I ins ted the elechical installation described herein on fhe dates stafed
Irrigation Boom RougMn pare
Special Inspection
Investigative f ►"' F�— � - �O– o/
THIS INSTALLATION M Y E ORDERED DISCONNECTED IF NOT COMPLETED �HIN_18 MONTH�_ _
OFFlCE USE ONLY This requesf void 18 month alidation date priMed in this Iwx.
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* 0 8 4 5 1 2 0 5* �l��p
PLEASE PRINT OR TYPE
Request Date Rou Min ins on r uired? ❑ Yes
� � ^� g pecli eq ❑ No I�spection Other Than RougMn� ❑ Ready Now � Will Call _
y�`fou musf call �e inspeclor when ready) Date Ready:
I, censed contractor ❑ owner h by request inspection of the above elecfrical work at:
Job ddress (SMeet, Bo r Route N City�.�� Zip Code
�
$ecfion No. Township Name or Range No. Fire No. Coun
Occupant Phone No.
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Power Supplier � Address
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Electrical Conhactor (Company Name) Conhacfor License No. Masfer lic. No. �Plant Elect. Only)
DEPENDABLE ELECTRIC. INC. �O 3
�I�i d r Qon � �I r nstallation)
Coon Rapids, MN 55433 , r• ,t..
Aufhorized Signature �Conhacfo her PerForming Installofion) Phone No.
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EB-0OOOIA-I 1 96 STA O Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY